Public Policy is social agreement written down as a universal guide for social action. We at The Policy ThinkShop share information so others can think and act in the best possible understanding of "The Public Interest."

The Policy ThinkShop provides you with the key reports and policy papers needed to help you participate in the current national debate addressing the implementation of the ACA insurance reform and in the ongoing mobilization of the philanthropic sector needed to transform how we view and support our own health and wellbeing within the lifestyle choices available to us in our communities, employment, educational system and civic life.

Building a healthier America will require much more than giving people health insurance cards

Investing in community health makes perfect economic, moral and public health sense. But this lesson is lost on politics. The nation’s corrosive political discourse consistently obfuscates the growing national consensus that healthcare dollars alone cannot give us a healthy society.

RWJF is developing a vision of good health that begins with individuals in their community environments. This new approach to talking about the state of our healthcare system and of the health of our citizens goes beyond the traditional debate about healthcare costs, the need for a more cost-effective healthcare system that focuses on prevention of disease; and it goes beyond the need for access to and delivery of quality healthcare services that lead to improvements in health status for most Americans. This new focus centers on individuals, their health related behaviors and the social context in which those behaviors occur. The idea is that investing in a community environment that promotes a healthy lifestyle will prevent disease and healthcare problems before they arise. This in turn will lessen the burden on our currently expensive and inefficient healthcare system.

The RWJF initiative to promote a healthier America is defined and operationalized in the following report. This vision also coincides with the current interest in ACA healthcare insurance reform. The second report which follows also addresses why all of the states should see the current medicaid expansion as economically beneficial in terms of increased revenue coming from the federal government and costs savings coming directly from their investment in medicaid expansion at the local level.

New Recommendations from the RWJF Commission to Build a Healthier America

A review of state-level fiscal studies found comprehensive analyses from 16 diverse states. Each analysis concluded that expansion helps state budgets. State savings and new state revenues exceeded increased state Medicaid expenses, with the federal government paying a high share of expansion costs. Even if future lawmakers reduce federal Medicaid spending, high federal matching rates are likely to remain at the ACA’s enhanced rates, given historic patterns. Facing bipartisan gubernatorial opposition, Congress lowered the federal share of Medicaid spending just once since 1980, while cutting Medicaid eligibility, services, and provider payments more than 100 times. Medicaid expansion thus offers significant state-level fiscal and economic benefits, along with increased health coverage.

A review of state-level fiscal studies found comprehensive analyses from 16 diverse states. Each analysis concluded that expansion helps state budgets. State savings and new state revenues exceeded increased state Medicaid expenses, with the federal government paying a high share of expansion costs. Even if future lawmakers reduce federal Medicaid spending, high federal matching rates are likely to remain at the ACA’s enhanced rates, given historic patterns. Facing bipartisan gubernatorial opposition, Congress lowered the federal share of Medicaid spending just once since 1980, while cutting Medicaid eligibility, services, and provider payments more than 100 times. Medicaid expansion thus offers significant state-level fiscal and economic benefits, along with increased health coverage.

If we are going to be successful in improving our healthcare system, we are going to have to make a difference in the quality of healthcare provided, access to care, health literacy on the part of consumers of care; and we will have to make it easier to live a healthier lifestyle for those most at risk. But how can we do this and where do we start?

Any effort that seeks to address healthcare quality and costs, both categories that seem to top the chart for both consumers, payers, political leaders, and policy makers, must address the continuum of prevention, intervention, followup, evaluation, and implementation of findings. The process of true healthcare reform must begin with each individual and the social and economic context in which he or she must navigate (health literacy) to achieve an optimal health lifestyle. The most significant challenge for a culturally diverse society like ours in the area of supporting and addressing lifestyle with the goal of improving health is communication. In the area of healthcare this means optimal interpersonal health communication between provider and service recipient. What do patients who experience communication dissonance in the healthcare encounter think of the physician – patient encounter? That’s where we need to begin.

“Patient-reported experiences of care are an important focus in health disparities research. This study explored the association of patient-reported experiences of care with race and acculturation status in a primary care setting. 881 adult patients (African-American 34%; Hispanic–classified as unacculturated or biculturated–31%; Caucasian 33%; missing race 2%), in outpatient Family Medicine clinics, completed a written survey in Spanish or English. Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group (CAG) Survey Adult Primary Care instrument was used for experiences of care and Short Form-12 survey for health status. Controlling for other variables, race and acculturation were significantly associated with several CAG subscales. Hispanic patients gave significantly higher ratings for care experiences and expressed greater interest in shared decision making. Selected patient-reported measures of care are associated with patients’ race and acculturation status (for Hispanic patients). We discuss implications for both provision and measurement of quality care.”

Does your community relations model incorporate new technologies, social media and senior citizens? Why not? Is your marketing vision inclusive of recent technological change and all its potential? Do you see technology as something that is inherently for the young? Think again…

When it comes to community organizing, community building and solving local problems don’t leave seniors out. Do not assume that age alone is keeping baby boomers out of the social scene. According to PEW there is a growing potential in the way seniors are using new technology and it may have very positive implications for your community organizing goals …

As of April 2012, 53% of American adults ages 65 and older use the internet or email. Though these adults are still less likely than all other age groups to use the internet, the latest data represent the first time that half of seniors are going online. After several years of very little growth among this group, these gains are significant.

Overall, 82% of all American adults ages 18 and older say they use the internet or email at least occasionally, and 67% do so on a typical day.

Once online, most seniors make internet use a regular part of their lives.

For most online seniors, internet use is a daily fixture in their lives. Among internet users ages 65 and older, 70% use the internet on a typical day. (Overall, 82% of all adult internet users go online on an average day.)

After age 75, internet and broadband use drops off significantly.

Internet usage is much less prevalent among members of the “G.I. Generation” (adults who are currently ages 76 and older)1 than among other age groups. As of April 2012, internet adoption among this group has only reached 34%, while home broadband use has inched up to 21%.

Seven in ten seniors own a cell phone, up from 57% two years ago.

A growing share of seniors own a cell phone. Some 69% of adults ages 65 and older report that they have a mobile phone, up from 57% in May 2010. Even among those currently ages 76 and older, 56% report owning a cell phone of some kind, up from 47% of this generation in 2010. Despite these increases, however, older adults are less likely than other age groups to own these devices. Some 88% of all adults own a cell phone, including 95% of those ages 18-29.

One in three online seniors uses social networking sites like Facebook and LinkedIn.

Social networking site use among seniors has grown significantly over the past few years: From April 2009 to May 2011, for instance, social networking site use among internet users ages 65 and older grew 150%, from 13% in 2009 to 33% in 2011. As of February 2012, one third (34%) of internet users ages 65 and older use social networking sites such as Facebook, and 18% do so on a typical day. Among all adult internet users, 66% use social networking sites (including 86% of those ages 18-29), with 48% of adult internet users making use of these sites on a typical day.

By comparison, email use continues to be the bedrock of online communications for seniors. As of August 2011, 86% of internet users ages 65 and older use email, with 48% doing so on a typical day. Among all adult internet users, 91% use email, with 59% doing so on a typical day.”

“Marketing is rapidly becoming one of the most technology-dependent functions in business. In 2012 the research and consulting firm Gartner predicted that by 2017, a company’s chief marketing officer would be spending more on technology than its chief information officer was. That oft-quoted claim seems more credible every day.A new type of executive is emerging at the center of the transformation: the chief marketing technologist. CMTs are part strategist, part creative director, part technology leader, and part teacher. Although they have an array of titles—Kimberly-Clark has a “global head of marketing technology,” while SAP has a “business information officer for global marketing,” for example—they have a common job: aligning marketing technology with business goals, serving as a liaison to IT, and evaluating and choosing technology providers. About half are charged with helping craft new digital business models as well.Regardless of what they’re called, the best CMTs set a technology vision for marketing. They champion greater …”

The Kaiser Family Foundation has released its first survey of the population finding new health coverage under the recently implemented ACA reform. The survey delineates two main groups taking advantage of the increased access to health insurance: those who had non-group coverage and those who had no insurance at all. The experiences of these two groups may prove important, the report goes on to say, with significant implications on how the success of the ACA reform is judged.

Apparently, the success of the ACA reform in brining people into the insured fold may be limited by financial literacy, insurance literacy, and health literacy deficits evident in the Kaiser Family Foundation survey.

A preliminary read of the survey report findings by The Policy ThinkShop points to an emergent need to address health literacy in the newly covered group in order to ensure that coverage recipients understand how to take advantage of their presumed efficacy in the insurance market and in their presumed increased access to healthcare itself and cost saving prevention health services. According to the survey:

“Health insurance is complicated, and many previous studies have documented gaps in health insurance literacy among consumers. The survey finds evidence of this among those who purchase their own coverage, with many respondents unable to answer some basic questions about their plans. For example, nearly one in five non-group enrollees (18 percent) say they don’t know the amount of their monthly premium and almost four in ten (37 percent) don’t know the amount of their annual deductible. Among those with ACA-compliant plans, three in ten (30 percent) say they don’t know the metal level of their plan (platinum, gold, silver or bronze), and among those who report getting a government subsidy to defray their premium cost, nearly half (47 percent) couldn’t say what the amount of the subsidy is.”

The survey report goes on to highlight the segment of the population surveyed who are more privileged because of their prior experience obtaining insurance:

“Some groups are more knowledgeable than others, including college graduates, those with higher incomes, and small business owners. Plan switchers, who likely have more experience buying coverage in the non-group market, are also more likely than those who were previously uninsured to be able to report the metal level of their plan and their premium and deductible amounts.”

“January 1, 2014 marked the beginning of several provisions of the Affordable Care Act ACA making significant changes to the non-group insurance market, including new rules for insurers regarding who they must cover and what they can charge, along with the opening of new Health Insurance Marketplaces also known as “Exchanges” and the availability of premium and cost-sharing subsidies for individuals with low to moderate incomes. Data from the Department of Health and Human Services and others provide some insight into how many people purchased insurance using the new Marketplaces and the types of plans they picked, but much remains unknown about changes to the non-group market as a whole. The Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees is the first in a series of surveys taking a closer look at the entire non-group market. This first survey was conducted from early April to early May 2014, after the close of the first ACA open enrollment period. It reports the views and experience of all non-group enrollees, including those with coverage obtained both inside and outside the Exchanges, and those who were uninsured prior to the ACA as well as those who had a previous source of coverage non-group or otherwise.”

Addressing health problems in communities takes more than understanding what causes them or who they impact most. It takes a motivated network of stakeholders to define policies, bring resources, and build appropriate programs. What can you do to successfully convene and motivate local thought leaders to help you in your public health cause?

Motivating others to work with you requires a command of the relevant facts to build a reasonable conversation. Commanding local data, defining local health problems (in terms of needed policies, plans and programs) will help you form a team of local stakeholders that can support your vision of a healthier community.

This year the RWJF released its fifth edition of its county health ranking report. The report focuses on the relationship between how you feel and where you live. The website provides a user friendly set of online tools for understanding demographic variables and performing health analysis that can help you increase your “health literacy” as a community member, stakeholder, policy maker and leader with a focus on addressing community health challenges.

The following resources will help you make progress on the health issues impacting your community.

The Policy ThinkShop provides you with the following summary of the findings and user friendly links to the website where you can plugin your state, county, etc., and get your data:

The rate of preventable hospital stays decreased about 20 percent from 2003 to 2011.

Smoking rates dropped from 21 percent in 2005 to 18 percent in 2012.

Completion of at least some college attendance increased slightly from 59 percent in 2005 to 64 percent in 2012.

This year’s report also features several new measures:

Housing:

Almost 1 in 5 households are overcrowded, pose a severe cost burden, or lack adequate facilities to cook, clean, or bathe.

These problems are greatest on the East and West coasts, in Alaska, and in parts of the South.

Transportation:

More than three-quarters of workers drive to work alone and among them 33 percent drive longer than a half hour each way.

Driving contributes to physical inactivity, obesity and air pollution.

Food Environment:

People in many parts of the country face food insecurity or the threat of hunger and limited access to healthy foods, especially in counties in the Southwest, across parts of the South and in the Western United States.

Mental Health:

Amid growing attention to mental health care, the availability of mental health providers in the healthiest counties in each state is 1.3 times higher than in the least healthy counties.

The west and northeast regions of the country have the best access to mental health providers.

Injury-Related Deaths:

The third-leading cause of death in the United States, injury death rates are 1.7 times higher in the least healthy counties than in the healthiest counties.

These rates are particularly high in the Southwest, part of the Northwest including Alaska and in the East South Central and Appalachian regions.

Exercise Opportunities:

Access to parks or recreational facilities in the healthiest counties is 1.4 times higher than in the least healthy counties.”

America’s work is work, but it’s not working very well. Let us explain.

The world economy has been transformed the American job market does not now seem able to sustain the large middle class that many argue made American great and unique.

“The U.S. finally clawed back all the jobs lost since the recession hit in late 2007, a watershed in a grindingly slow recovery that finds a labor market still in many ways weaker now than before the downturn.U.S. payrolls in May hit an all-time high after the first four-month stretch of job creation above 200,000 since the boom days of the late 1990s, according to the Labor Departments latest employment report. In all, employers added 217,000 jobs last month, nudging payrolls above the prior peak in January 2008.”

Perhaps one of the most terrible things about life is that it ends. At the same time, the fragility of life is perhaps what also makes it beautiful and precious for many of us. And so, it is perhaps most painful when we have to see others die than it is to finally succumb ourselves. In the behavioral health profession this process of experiencing the death of others is referred to at grief and loss… Most of us do not handle it very well. Both the lead up to it, the moment when it happens and then our often long process of trying to understand and deal with it.

The Policy ThinkShop recommends the following Harvard medical resource to help you broaden your perspective on death and dying–the inevitable crisis we often face more than once in our lives.

“Compassionate advice for dealing with the loss of a loved one. The loss of a loved one can be a profoundly painful experience. The grief that follows may permeate everything, making it hard to eat, sleep, or muster much interest in the life going on around you.

This emotional maelstrom can affect behavior and judgment. It’s common, for example, to feel agitated or exhausted, to sob unexpectedly, or to withdraw from the world. Some people find themselves struggling with feelings of sorrow, numbness, anger, guilt, despair, irritability, relief, or anxiety.

While no words can erase grief, Coping with Grief and Loss can help you navigate this turbulent time.

In its pages, you’ll find advice on comforting yourself, commemorating your loved one, and understanding the difference between grief and depression. You’ll also find special sections on coping with the loss of a child, parent, or spouse.

Coping with Grief and Loss also includes information on navigating life when a loved one is terminally ill, on end-of-life planning, and on ways to talk about death.

Loss affects people in different ways. There is no “right” way to grieve, and no timetable or schedule for grieving. This Special Health Report aims to help you cope with the loss of a loved one at your own pace and in your own way. It offers numerous physical, emotional, and social strategies that help healing take place.”

When it comes to community organizing, community building and solving local problems don’t leave seniors out. Do not assume that age alone is keeping baby boomers out of the social scene. According to PEW there is a growing potential in the way seniors are using new technology and it may have very positive implications for your community organizing goals …

As of April 2012, 53% of American adults ages 65 and older use the internet or email. Though these adults are still less likely than all other age groups to use the internet, the latest data represent the first time that half of seniors are going online. After several years of very little growth among this group, these gains are significant.

Overall, 82% of all American adults ages 18 and older say they use the internet or email at least occasionally, and 67% do so on a typical day.

Once online, most seniors make internet use a regular part of their lives.

For most online seniors, internet use is a daily fixture in their lives. Among internet users ages 65 and older, 70% use the internet on a typical day. (Overall, 82% of all adult internet users go online on an average day.)

After age 75, internet and broadband use drops off significantly.

Internet usage is much less prevalent among members of the “G.I. Generation” (adults who are currently ages 76 and older)1 than among other age groups. As of April 2012, internet adoption among this group has only reached 34%, while home broadband use has inched up to 21%.

Seven in ten seniors own a cell phone, up from 57% two years ago.

A growing share of seniors own a cell phone. Some 69% of adults ages 65 and older report that they have a mobile phone, up from 57% in May 2010. Even among those currently ages 76 and older, 56% report owning a cell phone of some kind, up from 47% of this generation in 2010. Despite these increases, however, older adults are less likely than other age groups to own these devices. Some 88% of all adults own a cell phone, including 95% of those ages 18-29.

One in three online seniors uses social networking sites like Facebook and LinkedIn.

Social networking site use among seniors has grown significantly over the past few years: From April 2009 to May 2011, for instance, social networking site use among internet users ages 65 and older grew 150%, from 13% in 2009 to 33% in 2011. As of February 2012, one third (34%) of internet users ages 65 and older use social networking sites such as Facebook, and 18% do so on a typical day. Among all adult internet users, 66% use social networking sites (including 86% of those ages 18-29), with 48% of adult internet users making use of these sites on a typical day.

By comparison, email use continues to be the bedrock of online communications for seniors. As of August 2011, 86% of internet users ages 65 and older use email, with 48% doing so on a typical day. Among all adult internet users, 91% use email, with 59% doing so on a typical day.”

The National Center for Education Statistics is following the young. It is doing so for very important reasons. What becomes of America’s youth post educational experience?

This query is significant for most today because the recent deep and lingering recession has shaken many of the tenets families have long taken for granted: Go to college, do well, graduate, marry well, do well… This “fairy tale” may no longer be the case for a significant number of young adults. This is especially troubling for baby boomer parents who have experience a lifetime of social mobility and progress. As the baby boomers age, they are increasingly troubled by an unexpected contradiction in today’s economy: you may have done all the rights things and your parents may have done their very best, and you are still not ready for success years after you left your university cocoon.

The Policy ThinkShop invites you to read and comment on the following report by the National Center for Education Statistics so that you can help us give perspective to the growing debate addressing the inadequacies of our educational system as these relate to the emerging labor market.

“The Education Longitudinal Study of 2002 (ELS:2002) tracks the educational and developmental experiences of a nationally representative sample of high school sophomores in the United States.1 This First Look report provides a descriptive portrait of these 2002 tenth-graders a decade later, when most were about 26 years old and had been out of high school for 8 years. In so doing, this report draws heavily on information collected during the 2012 third follow-up data collection.2 By this time, many members of the cohort had already completed postsecondary education, started or even changed careers, and started to form families.”

If you are 50 years or older this year, you are a baby boomer. You are part of the largest generation and you and your demographic cohort have been making waves and will continue to do so well past mid century into the 2050s. Ironically, the baby boomers made much of their generational ruckus by not getting along with their parents and the lifestyle given to them by those parents which they proceeded to tear asunder. Well, it appears that the boomers are at it once again, making waves, changing the lifestyle of previous “Seniors” and once again creating a conflict between the old and the young… This time it is the boomers who are the elders and, once again, they are in conflict—this time with the generation behind them. They are refusing to leave a job market that has already been quite harsh to the generations behind the boomers ….

“True to their \”live to work\” reputation, some baby boomers are digging in their heels at the workplace as they approach the traditional retirement age of 65. While the average age at which U.S. retirees say they retired has risen steadily from 57 to 61 in the past two decades, boomers — the youngest of whom will turn 50 this year — will likely extend it even further. Nearly half (49%) of boomers still working say they don\’t expect to retire until they are 66 or …”

The Policy ThinkShop team wishes you and all of our visitors this year a happy holiday season and a prosperous new year!

Here are some fun facts about our health that will get us thinking about a healthier future and a happy 2014 from the Gallup organization:

Highlights from the health and well-being findings Gallup.com published in 2013

WASHINGTON, D.C. — Gallup published nearly 100 unique articles in 2013 about Americans\’ health and well-being. Through its daily surveys, conducted year-round, the Gallup-Healthways Well-Being Index uncovers new insights and provides the most up-to-date data available on Americans\’ mental state, exercise and eating habits, healthcare coverage, physical health, and financial well-being. The following list represents Gallup editors\’ picks for the top 10 most important findings from this year.

Lacking employment is most linked to having depression: For Americans, being unemployed, being out of the workforce, or working part time — but wanting full-time work — are the strongest predictors of having depression. Gallup found that these relationships hold true even after controlling for age, gender, income, education, race and ethnicity, marital status, having children, region, obesity, having health insurance, and being a caregiver. Bonus finding: Depression costs U.S. employers $23 billion in absenteeism each year.

Obesity is a growing problem for Americans: The adult obesity rate has been trending upward in 2013 will likely surpass rates since 2008, when Gallup and Healthways began tracking. The obesity rate has increased across almost all demographic groups.

Those who are actively disengaged at work are more likely to smoke: Eighteen percent of actively disengaged workers — those who are emotionally disconnected from their jobs — light up vs. 15% of other workers. Bonus finding: Workers who smoke cost the U.S. economy $278 billion annually.

Female veterans have a more optimistic life outlook: Female veterans of the U.S. military have a much more optimistic outlook on their lives than their male counterparts do. Female veterans\’ future life ratings are similar to those of women in the general U.S. population, but male veterans\’ ratings trail behind other men\’s ratings.

Heart attacks hit women harder, emotionally speaking: American women who say they have had a heart attack at some point in their lives have an average Emotional Health Index score that is eight points lower than the average score among women who have not had a heart attack. In comparison, the average Emotional Health Index score among men who have had a heart attack is four points lower than it is among men who have not.

Depression rate drops in areas hardest hit by Sandy: One year after Superstorm Sandy, reports of clinical depression among those living in the hardest hit areas have mostly recovered to levels seen before the storm. But reports of anger in the most affected areas have increased. Bonus finding: More residents smoke and fewer eat healthily than before the storm.

Income more to blame for obesity than food deserts: In a first-of-its-kind study exploring the relationship between adult obesity and food deserts, Gallup found that lack of access to grocery stores alone doesn\’t matter in terms of obesity; it only matters when Americans also have low incomes. But being low-income is associated with higher obesity rates, regardless of access to food.

Engaged employees have a healthier lifestyle: Employees who are engaged at work are more likely to report eating healthier, exercising more frequently, and consuming more fruits and vegetables than workers who are not engaged or who are actively disengaged.

Single-parent households struggle more to afford food: Thirty-one percent of single-parent households said there were times in the past 12 months when they struggled to afford food, compared with 19% two-parent households. Younger parents and parents with three or more children also had more trouble affording food at times.

Among U.S. workers, lack of exercise is linked more to obesity than eating habits: Exercising fewer than three days a week is more closely linked to U.S. workers being obese than any of 26 other behavioral factors, including healthy eating. This held true even while controlling for age, ethnicity, race, marital status, gender, income, education, region, and religiosity.

An aging America may not necessarily be a quiet and content America. People born in the post war boom, challenged religion, government and authority in all their forms. As an aging generation, they want the healthcare system to take care of them.

Baby boomers have grown up in what can be termed the age of technology and optimism, with mankind at the center of the universe and economic progress an ever churning engine. Much of the healthcare conversation in America is not about doctors and patients but about costs and insurance. Americans spend a great deal of money on healthcare. All the recent talk about healthcare seems to be impacting expectations on the role of doctors and healthcare outcomes. Americans expect doctors to save lives.

One of the challenges of healthcare in America is getting people to understand it, to connect their behavioral choices with healthcare outcomes and to value wellness over consumption. Feeling good does not always lead to feeling well. America can be an indulgent society and today’s youth want it all and they want it now. Americans do not value their healthcare until it is a problem they can feel or until they understand what is happening to them as something that can threaten their mortality. Americans want to live for ever and their attitudes regarding the role that a physician should play regarding preserving life is moving in that direction.

“At a time of national debate over health care costs and insurance, a Pew Research Center survey on end-of-life decisions finds most Americans say there are some circumstances in which doctors and nurses should allow a patient to die. At the same time, however, a growing minority says that medical professionals should do everything possible to save a patient’s …”

In seemingly endless times of “trash talk” that led to an improbable and unpopular political victory, the newly minted president clamors: “Now arrives the hour of action.” Fleeting relief comes to the nation as the transition […]

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